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Motchon YD, Sack KL, Sirry MS, Nchejane NJ, Abdalrahman T, Nagawa J, Kruger M, Pauwels E, Van Loo D, De Muynck A, Van Hoorebeke L, Davies NH, Franz T. In silico Mechanics of Stem Cells Intramyocardially Transplanted with a Biomaterial Injectate for Treatment of Myocardial Infarction. Cardiovasc Eng Technol 2024:10.1007/s13239-024-00734-1. [PMID: 38782879 DOI: 10.1007/s13239-024-00734-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 05/12/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Biomaterial and stem cell delivery are promising approaches to treating myocardial infarction. However, the mechanical and biochemical mechanisms underlying the therapeutic benefits require further clarification. This study aimed to assess the deformation of stem cells injected with the biomaterial into the infarcted heart. METHODS A microstructural finite element model of a mid-wall infarcted myocardial region was developed from ex vivo microcomputed tomography data of a rat heart with left ventricular infarct and intramyocardial biomaterial injectate. Nine cells were numerically seeded in the injectate of the microstructural model. The microstructural and a previously developed biventricular finite element model of the same rat heart were used to quantify the deformation of the cells during a cardiac cycle for a biomaterial elastic modulus (Einj) ranging between 4.1 and 405,900 kPa. RESULTS The transplanted cells' deformation was largest for Einj = 7.4 kPa, matching that of the cells, and decreased for an increase and decrease in Einj. The cell deformation was more sensitive to Einj changes for softer (Einj ≤ 738 kPa) than stiffer biomaterials. CONCLUSIONS Combining the microstructural and biventricular finite element models enables quantifying micromechanics of transplanted cells in the heart. The approach offers a broader scope for in silico investigations of biomaterial and cell therapies for myocardial infarction and other cardiac pathologies.
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Affiliation(s)
- Y D Motchon
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Observatory, South Africa.
| | - K L Sack
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Observatory, South Africa
- Cardiac Rhythm Management, Medtronic Inc, Minneapolis, MN, USA
| | - M S Sirry
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Observatory, South Africa
- Department of Biomedical Engineering, School of Engineering and Computing, American International University, Al Jahra, Kuwait
| | - N J Nchejane
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Observatory, South Africa
| | - T Abdalrahman
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Observatory, South Africa
| | - J Nagawa
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Observatory, South Africa
| | - M Kruger
- Cardiovascular Research Unit, University of Cape Town, Observatory, South Africa
| | - E Pauwels
- Centre for X-ray Tomography, Department of Physics and Astronomy, Ghent University, Ghent, Belgium
| | - D Van Loo
- Centre for X-ray Tomography, Department of Physics and Astronomy, Ghent University, Ghent, Belgium
- XRE nv, Bollebergen 2B box 1, Ghent, 9052, Belgium
| | - A De Muynck
- Centre for X-ray Tomography, Department of Physics and Astronomy, Ghent University, Ghent, Belgium
| | - L Van Hoorebeke
- Centre for X-ray Tomography, Department of Physics and Astronomy, Ghent University, Ghent, Belgium
| | - N H Davies
- Cardiovascular Research Unit, University of Cape Town, Observatory, South Africa
| | - T Franz
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Observatory, South Africa.
- Bioengineering Science Research Group, Department of Mechanical Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK.
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2
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Xu F, Dawson C, Lamb M, Mueller E, Stefanek E, Akbari M, Hoare T. Hydrogels for Tissue Engineering: Addressing Key Design Needs Toward Clinical Translation. Front Bioeng Biotechnol 2022; 10:849831. [PMID: 35600900 PMCID: PMC9119391 DOI: 10.3389/fbioe.2022.849831] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/12/2022] [Indexed: 12/15/2022] Open
Abstract
Graphical Abstract
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Affiliation(s)
- Fei Xu
- Department of Chemical Engineering, McMaster University, Hamilton, ON, Canada
| | - Chloe Dawson
- Department of Chemical Engineering, McMaster University, Hamilton, ON, Canada
| | - Makenzie Lamb
- Department of Chemical Engineering, McMaster University, Hamilton, ON, Canada
| | - Eva Mueller
- Department of Chemical Engineering, McMaster University, Hamilton, ON, Canada
| | - Evan Stefanek
- Department of Mechanical Engineering, University of Victoria, Victoria, BC, Canada
- Center for Advanced Materials and Related Technologies, University of Victoria, Victoria, BC, Canada
| | - Mohsen Akbari
- Department of Mechanical Engineering, University of Victoria, Victoria, BC, Canada
- Center for Advanced Materials and Related Technologies, University of Victoria, Victoria, BC, Canada
- Biotechnology Center, Silesian University of Technology, Gliwice, Poland
- *Correspondence: Mohsen Akbari, ; Todd Hoare,
| | - Todd Hoare
- Department of Chemical Engineering, McMaster University, Hamilton, ON, Canada
- *Correspondence: Mohsen Akbari, ; Todd Hoare,
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Ramírez WA, Gizzi A, Sack KL, Guccione JM, Hurtado DE. In-silico study of the cardiac arrhythmogenic potential of biomaterial injection therapy. Sci Rep 2020; 10:12990. [PMID: 32737400 PMCID: PMC7395773 DOI: 10.1038/s41598-020-69900-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 06/19/2020] [Indexed: 02/06/2023] Open
Abstract
Biomaterial injection is a novel therapy to treat ischemic heart failure (HF) that has shown to reduce remodeling and restore cardiac function in recent preclinical studies. While the effect of biomaterial injection in reducing mechanical wall stress has been recently demonstrated, the influence of biomaterials on the electrical behavior of treated hearts has not been elucidated. In this work, we developed computational models of swine hearts to study the electrophysiological vulnerability associated with biomaterial injection therapy. The propagation of action potentials on realistic biventricular geometries was simulated by numerically solving the monodomain electrophysiology equations on anatomically-detailed models of normal, HF untreated, and HF treated hearts. Heart geometries were constructed from high-resolution magnetic resonance images (MRI) where the healthy, peri-infarcted, infarcted and gel regions were identified, and the orientation of cardiac fibers was informed from diffusion-tensor MRI. Regional restitution properties in each case were evaluated by constructing a probability density function of the action potential duration (APD) at different cycle lengths. A comparative analysis of the ventricular fibrillation (VF) dynamics for every heart was carried out by measuring the number of filaments formed after wave braking. Our results suggest that biomaterial injection therapy does not affect the regional dispersion of repolarization when comparing untreated and treated failing hearts. Further, we found that the treated failing heart is more prone to sustain VF than the normal heart, and is at least as susceptible to sustained VF as the untreated failing heart. Moreover, we show that the main features of VF dynamics in a treated failing heart are not affected by the level of electrical conductivity of the biogel injectates. This work represents a novel proof-of-concept study demonstrating the feasibility of computer simulations of the heart in understanding the arrhythmic behavior in novel therapies for HF.
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Affiliation(s)
- William A Ramírez
- Department of Structural and Geotechnical Engineering, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alessio Gizzi
- Nonlinear Physics and Mathematical Modeling Lab, Department of Engineering, Campus Bio-Medico University of Rome, Rome, Italy
| | - Kevin L Sack
- Department of Surgery, University of California at San Francisco, San Francisco, CA, USA
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Julius M Guccione
- Department of Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Daniel E Hurtado
- Department of Structural and Geotechnical Engineering, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile.
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4
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Sack KL, Aliotta E, Choy JS, Ennis DB, Davies NH, Franz T, Kassab GS, Guccione JM. Intra-myocardial alginate hydrogel injection acts as a left ventricular mid-wall constraint in swine. Acta Biomater 2020; 111:170-180. [PMID: 32428678 PMCID: PMC7368390 DOI: 10.1016/j.actbio.2020.04.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023]
Abstract
Despite positive initial outcomes emerging from preclinical and early clinical investigation of alginate hydrogel injection therapy as a treatment for heart failure, the lack of knowledge about the mechanism of action remains a major shortcoming that limits the efficacy of treatment design. To identify the mechanism of action, we examined previously unobtainable measurements of cardiac function from in vivo, ex vivo, and in silico states of clinically relevant heart failure (HF) in large animals. High-resolution ex vivo magnetic resonance imaging and histological data were used along with state-of-the-art subject-specific computational model simulations. Ex vivo data were incorporated in detailed geometric computational models for swine hearts in health (n = 5), ischemic HF (n = 5), and ischemic HF treated with alginate hydrogel injection therapy (n = 5). Hydrogel injection therapy mitigated elongation of sarcomere lengths (1.68 ± 0.10μm [treated] vs. 1.78 ± 0.15μm [untreated], p<0.001). Systolic contractility in treated animals improved substantially (ejection fraction = 43.9 ± 2.8% [treated] vs. 34.7 ± 2.7% [untreated], p<0.01). The in silico models realistically simulated in vivo function with >99% accuracy and predicted small myofiber strain in the vicinity of the solidified hydrogel that was sustained for up to 13 mm away from the implant. These findings suggest that the solidified alginate hydrogel material acts as an LV mid-wall constraint that significantly reduces adverse LV remodeling compared to untreated HF controls without causing negative secondary outcomes to cardiac function. STATEMENT OF SIGNIFICANCE: Heart failure is considered a growing epidemic and hence an important health problem in the US and worldwide. Its high prevalence (5.8 million and 23 million, respectively) is expected to increase by 25% in the US alone by 2030. Heart failure is associated with high morbidity and mortality, has a 5-year mortality rate of 50%, and contributes considerably to the overall cost of health care ($53.1 billion in the US by 2030). Despite positive initial outcomes emerging from preclinical and early clinical investigation of alginate hydrogel injection therapy as a treatment for heart failure, the lack of knowledge concerning the mechanism of action remains a major shortcoming that limits the efficacy of treatment design. To understand the mechanism of action, we combined high-resolution ex vivo magnetic resonance imaging and histological data in swine with state-of-the-art subject-specific computational model simulations. The in silico models realistically simulated in vivo function with >99% accuracy and predicted small myofiber strain in the vicinity of the solidified hydrogel that was sustained for up to 13 mm away from the implant. These findings suggest that the solidified alginate hydrogel material acts as a left ventricular mid-wall constraint that significantly reduces adverse LV remodeling compared to untreated heart failure controls without causing negative secondary outcomes to cardiac function. Moreover, if the hydrogel can be delivered percutaneously rather than via the currently used open-chest procedure, this therapy may become routine for heart failure treatment. A minimally invasive procedure would be in the best interest of this patient population; i.e., one that cannot tolerate general anesthesia and surgery, and it would be significantly more cost-effective than surgery.
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Affiliation(s)
- Kevin L Sack
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California at San Francisco, Box 0118, UC Hall Room U-158, San Francisco, CA, United States; Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Eric Aliotta
- Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Jenny S Choy
- California Medical Innovations Institute, Inc., San Diego, California, USA
| | - Daniel B Ennis
- Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Neil H Davies
- Cardiovascular Research Unit, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Thomas Franz
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa; Bioengineering Science Research Group, Engineering Sciences, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK
| | - Ghassan S Kassab
- California Medical Innovations Institute, Inc., San Diego, California, USA
| | - Julius M Guccione
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California at San Francisco, Box 0118, UC Hall Room U-158, San Francisco, CA, United States.
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Neves MI, Moroni L, Barrias CC. Modulating Alginate Hydrogels for Improved Biological Performance as Cellular 3D Microenvironments. Front Bioeng Biotechnol 2020; 8:665. [PMID: 32695759 PMCID: PMC7338591 DOI: 10.3389/fbioe.2020.00665] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/28/2020] [Indexed: 01/09/2023] Open
Abstract
The rational choice and design of biomaterials for biomedical applications is crucial for successful in vitro and in vivo strategies, ultimately dictating their performance and potential clinical applications. Alginate, a marine-derived polysaccharide obtained from seaweeds, is one of the most widely used polymers in the biomedical field, particularly to build three dimensional (3D) systems for in vitro culture and in vivo delivery of cells. Despite their biocompatibility, alginate hydrogels often require modifications to improve their biological activity, namely via inclusion of mammalian cell-interactive domains and fine-tuning of mechanical properties. These modifications enable the addition of new features for greater versatility and control over alginate-based systems, extending the plethora of applications and procedures where they can be used. Additionally, hybrid systems based on alginate combination with other components can also be explored to improve the mimicry of extracellular microenvironments and their dynamics. This review provides an overview on alginate properties and current clinical applications, along with different strategies that have been reported to improve alginate hydrogels performance as 3D matrices and 4D dynamic systems.
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Affiliation(s)
- Mariana Isabel Neves
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal.,FEUP - Faculdade de Engenharia da Universidade do Porto, Porto, Portugal
| | - Lorenzo Moroni
- MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, Netherlands.,CNR NANOTEC - Institute of Nanotechnology, Università del Salento, Lecce, Italy
| | - Cristina Carvalho Barrias
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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6
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Cork TE, Perotti LE, Verzhbinsky IA, Loecher M, Ennis DB. High-Resolution Ex Vivo Microstructural MRI After Restoring Ventricular Geometry via 3D Printing. FUNCTIONAL IMAGING AND MODELING OF THE HEART : ... INTERNATIONAL WORKSHOP, FIMH ..., PROCEEDINGS. FIMH 2019; 11504:177-186. [PMID: 31432042 DOI: 10.1007/978-3-030-21949-9_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Computational modeling of the heart requires accurately incorporating both gross anatomical detail and local microstructural information. Together, these provide the necessary data to build 3D meshes for simulation of cardiac mechanics and electrophysiology. Recent MRI advances make it possible to measure detailed heart motion in vivo, but in vivo microstructural imaging of the heart remains challenging. Consequently, the most detailed measurements of microstructural organization and microanatomical infarct details are obtained ex vivo. The objective of this work was to develop and evaluate a new method for restoring ex vivo ventricular geometry to match the in vivo configuration. This approach aids the integration of high-resolution ex vivo microstructural information with in vivo motion measurements. The method uses in vivo cine imaging to generate surface meshes, then creates a 3D printed left ventricular (LV) blood pool cast and a pericardial mold to restore the ex vivo cardiac geometry to a mid-diastasis reference configuration. The method was evaluated in healthy (N = 7) and infarcted (N = 3) swine. Dice similarity coefficients were calculated between in vivo and ex vivo images for the LV cavity (0.93 ± 0.01), right ventricle (RV) cavity (0.80 ± 0.05), and the myocardium (0.72 ± 0.04). The R 2 coefficient between in vivo and ex vivo LV and RV cavity volumes were 0.95 and 0.91, respectively. These results suggest that this method adequately restores ex vivo geometry to match in vivo geometry. This approach permits a more precise incorporation of high-resolution ex vivo anatomical and microstructural data into computational models that use in vivo data for simulation of cardiac mechanics and electrophysiology.
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Affiliation(s)
- Tyler E Cork
- Department of Radiology, Stanford University, Stanford, CA 94305, USA.,Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Luigi E Perotti
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | | | - Michael Loecher
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
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7
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Varela CE, Fan Y, Roche ET. Optimizing Epicardial Restraint and Reinforcement Following Myocardial Infarction: Moving Towards Localized, Biomimetic, and Multitherapeutic Options. Biomimetics (Basel) 2019; 4:E7. [PMID: 31105193 PMCID: PMC6477619 DOI: 10.3390/biomimetics4010007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/31/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
The mechanical reinforcement of the ventricular wall after a myocardial infarction has been shown to modulate and attenuate negative remodeling that can lead to heart failure. Strategies include wraps, meshes, cardiac patches, or fluid-filled bladders. Here, we review the literature describing these strategies in the two broad categories of global restraint and local reinforcement. We further subdivide the global restraint category into biventricular and univentricular support. We discuss efforts to optimize devices in each of these categories, particularly in the last five years. These include adding functionality, biomimicry, and adjustability. We also discuss computational models of these strategies, and how they can be used to predict the reduction of stresses in the heart muscle wall. We discuss the range of timing of intervention that has been reported. Finally, we give a perspective on how novel fabrication technologies, imaging techniques, and computational models could potentially enhance these therapeutic strategies.
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Affiliation(s)
- Claudia E Varela
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA 02139, USA.
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Yiling Fan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Ellen T Roche
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA 02139, USA.
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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